Insights on diagnosis, prognosis and screening of renal cell carcinoma.

Malignant tumors of the kidney account for about 1.9% of total world cancers, with about 150,000 new cases annually. Renal parenchyma (renal cell) cancer represents around 80% of this total and nearly all of these cases are adenocarcinomas. As a whole, it is difficult to obtain clear descriptive patterns of incidence and mortality from renal cell cancer, since population data from different regions are presented conjointly with pelvis and ureter cancers. In Latin America, the highest incidence rates of kidney cancer are observed in Montevideo, Uruguay (10.6 per 100,000 males) and in Porto Alegre, Brazil (10.2 per 100,000 males). The São Paulo City Cancer Registry has reported a lower rate (6.9 per 100,000 males), but this is higher than the rates reported in Belém and Goiânia. The male/female ratio of kidney cancer in São Paulo is 1.9:1. The incidence of renal cell cancer and the associated mortality have increased throughout the world over the last 50 years. In the city of São Paulo too, increasing incidence of kidney cancer and associated mortality was observed from 1969 to 1998, but the specific rates for renal cell cancer could not be shown. The etiology of kidney cancer has not been well established yet, except for renal pelvis and ureter cancers, the majority of which are related to tobacco smoking. Nevertheless, cigarette smoking has been associated with a moderate risk of renal cell cancer, according to several case-control and cohort studies. It is also suspected that some drugs, such as phenacetin and diuretics (hydrochlorothiazide and furosemide), may give rise to a risk of renal cell cancer. 2